Artículos (Medicina)

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Vaccinated Patients Admitted in ICU with Severe Pneumonia Due to SARS-CoV-2: A Multicenter Pilot Study
(MDPI, 2021-10-25) Estella, Ángel; Cantón Bulnes, María Luisa; Muñoz, Laura; Rodriguez Higueras, Isabel; Recuerda Núñez, María; Tejero Aranguren, Julia; Zaya, Benito; Garnacho Montero, José; Group Of Infectious Diseases Of The Andalusian Society Of Intensive Care And Coronary Units Samiuc; Universidad de Sevilla. Departamento de Medicina
Background: The aim of this study was to analyze the percentage of patients admitted to the ICU having received the vaccine against COVID-19, to describe the clinical profile of vaccinated patients admitted to the ICU, and to assess the humoral immune response to vaccination. Methods: In this multicenter prospective descriptive cohort study, consecutive critically ill patients with confirmed SARS-CoV-2 pneumonia who received at least one dose of the SARS-CoV-2 vaccine were included. The time of study was from 1 July to 10 August of 2021. Results: Of the 94 consecutive patients from seven Andalusian ICUs admitted during the time of study, 50 (53.2%) received at least one dose of anti SARS-CoV-2 vaccine. No patient was admitted having previously had SARS-CoV-2 infection. The B.1.617.2 (Delta) variant was the most frequently identified, in 80.76% of cases. Patients with a complete vaccination with non-optimal antibody levels were immunocompromised. Fifteen patients were admitted to the ICU with Acute Respiratory Distress Syndrome (ARDS) without having completed their vaccination; the clinical profile was younger and with less comorbidities compared to patients with full vaccination. There were no differences in severity of ARDS. Conclusions: Most of the patients who were admitted to the ICU having received a dose of the vaccine were not optimally vaccinated; fully vaccinated patients who did not obtain optimal serum antibody levels were patients considered immunocompromised.
Negative predictive value of the repeated absence of gluten immunogenic peptides in the urine of treated celiac patients in predicting mucosal healing: new proposals for follow-up in celiac diseas
(Elsevier, 2020) Ruiz Carnicer, Ángela; Garzón Benavides, Marta; Fombuena, Blanca; Segura Montero, Verónica; García-Fernández, Francisco-José; Sobrino Rodríguez, Salvador; Coronel Rodríguez, Cristóbal; Romero Gómez, Manuel; Sousa Martín, Carolina; Comino Montilla, Isabel María; Argüelles Arias, Federico; Pizarro Moreno, Ángeles; Universidad de Sevilla. Departamento de Medicina; Universidad de Sevilla. Departamento de Microbiología y Parasitología; Universidad de Sevilla. Departamento de Farmacología, Pediatría y Radiología; Junta de Andalucía; European Commission (EC). Fondo Europeo de Desarrollo Regional (FEDER); Gobierno de España
Background: The treatment of celiac disease (CD) is a lifelong gluten-free diet (GFD). The current methods for monitoring GFD conformance, such as a dietary questionnaire or serology tests, may be inaccurate in detecting dietary transgressions, and duodenal biopsies are invasive, expensive, and not a routine monitoring technique. Objectives: Our aim was to determine the clinical usefulness of urine gluten immunogenic peptides (GIP) as a biomarker monitoring GFD adherence in celiac patients and to evaluate the concordance of the results with the degree of mucosal damage. Methods: A prospective observational study was conducted involving 22 de novo CD patients, 77 celiac patients consuming a GFD, and 13 nonceliac subjects. On 3 d of the week, urine samples were collected and the GIP concentrations were tested. Simultaneously, anti-tissue transglutaminase antibodies, questionnaire results, clinical manifestations, and histological findings were analyzed. Results: Approximately 24% (18 of 76) of the celiac patients consuming a GFD exhibited Marsh II–III mucosal damage. Among this population, 94% (17 of 18) had detectable urine GIP; however, between 60% and 80% were asymptomatic and exhibited negative serology and appropriate GFD adherence based on the questionnaire. In contrast, 97% (31 of 32) of the celiac patients without duodenal damage had no detectable GIP. These results demonstrated the high sensitivity (94%) and negative predictive value (97%) of GIP measurements in relation to duodenal biopsy findings. In the de novo CD-diagnosed cohort, 82% (18 of 22) of patients had measurable amounts of GIP in the urine. Conclusions: Determining GIP concentrations in several urine samples may be an especially convenient approach to assess recent gluten exposure in celiac patients and appears to accurately predict the absence of histological lesions. The introduction of GIP testing as an assessment technique for GFD adherence may help in ascertaining dietary compliance and to target the most suitable intervention during follow-up.
Ferric carboxymaltose reduces transfusions and hospital stay in patients with colon cancer and anemia
(Springer, 2016-03) Calleja, José Luis; Delgado, Salvadora; Val, Adolfo del; Hervás, Antonio; Larraona, José Luis; Terán, Álvaro; Colon Cancer Study Group; Argüelles Arias, Federico; Universidad de Sevilla. Departamento de Medicina
Purpose The purpose of the study was to evaluate the efficacy of preoperative intravenous (IV) ferric carboxymaltose (FCM) administration vs. no-IV iron in colon cancer (CC) anemic patients undergoing elective surgery with curative intention. Methods This was a multicenter, observational study includ- ing two cohorts of consecutive CC anemic patients: the no-IV iron treatment group was obtained retrospectively while FCM-treated patients were recorded prospectively. Results A total of 266 patients were included: 111 received FCM (median dose 1000 mg) and 155 were no-IV iron sub- jects. Both groups were similar in terms of demographic char- acteristics, tumor location, surgical approach, and intra- operative bleeding severity. The FCM group showed a signif- icant lower need for red blood cell (RBC) transfusion during the study (9.9 vs. 38.7 %; OR: 5.9, p<0.001). In spite of lower hemoglobin levels at baseline diagnosis and lower transfusion rates in the FCM group, the proportion of responders was significantly higher with respect to the no-IV group both at hospital admission (48.1 vs. 20.0 %, p<0.0001) and at 30 days post-surgery (80.0 vs. 48.9 %, p<0.0001). The percentage of patients with normalized hemoglobin levels was also higher in the FCM group (40.0 vs. 26.7 % at 30 days, p<0.05). A lower number of reinterventions and post-surgery complications were seen in the FCM group (20.7 vs. 26.5 %; p=0.311). The FCM group presented a significant shorter hospital stay (8.4±6.8 vs. 10.9±12.4 days to discharge; p<0.001). Conclusions Preoperative ferric carboxymaltose treatment in patients with CC and iron deficiency anemia significantly re- duced RBC transfusion requirements and hospital length of stay, reaching higher response rates and percentages of nor- malized hemoglobin levels both at hospital admission and 30 days post-surgery.
Is safety infliximab during pregnancy in patients with inflammatory bowel disease?
(Arán Ediciones, 2012) Argüelles Arias, Federico; Castro-Laria, Luisa; Barreiro-de-Acosta, Manuel; García-Sánchez, Mª Valle; Guerrero-Jiménez, Pedro; Gómez-García, Mª Rosa; Cordero-Ruiz, Patricia; Iglesias-Flores, Eva; Gómez-Camacho, Federico; Domínguez-Muñoz, Enrique J.; Herrerías-Gutiérrez, Juan Manuel; Universidad de Sevilla. Departamento de Medicina
Background: in most cases, inflammatory bowel disease (IBD) debuts at reproductive age. The data available in the literature show infliximab (IFX) to be a safe drug during pregnancy but there is very little evidence about the activity of the disease following drug withdrawal during pregnancy. Aims: determine the drug´s safety in pregnant women in our setting and assess its effect on the foetus, drawing on the experience of several hospitals. Secondly, observe the effect of treatment withdrawal on disease activity during pregnancy. Material and methods: a retrospective study was conducted of women with IBD who had received IFX treatment during pregnancy in five hospitals in Spain. Disease activity was assessed using Crohn´s Disease Activity Index, while UC was assessed using the Truelove-Witts Index in each trimester of pregnancy. Gestational age, weight and diseases in the foetus were determined at birth. Results: the study included 12 women with a mean age of 29 years; 4 had ulcerative colitis and 8 Crohn´s disease, with mean disease duration of 7 years. All but one, who was diagnosed during pregnancy, was receiving IFX treatment at conception. Six patients received uninterrupted treatment throughout the pregnancy, 2 requested voluntary interruption and in 3 cases treatment was interrupted in the third trimester as a precaution. They received a mean IFX dose of 400 mg every 8 weeks. Of the 6 patients who received continuous treatment, in 50% disease was held in remission. The 6 remaining patients suspended treatment for different reasons, presenting disease recurrence in all but one case (83.3%). Eight deliveries were vaginal and 4 by caesarean section. Newborns presented no congenital anomalies, intrauterine growth retardation or low birth weight and there was only one premature delivery. Conclusions: although cases included in the stduy are not significant, in our experience, IFX during pregnancy is a safe treatment for the mother and the foetus. In fact, in our study and in some cases, its withdrawal may lead to a worsening of the disease. However, further control studies are required with larger samples to obtain more representative findings.
Reply to: “Increased stroke risk in patients with Parkinson's disease with LRRK2 mutations”
(WILEY, 2022-05-19) Macías-García, Daniel; Periñan Tocino, Maria Teresa; Muñoz-Delgado, Laura; Jesús, Silvia; Jimenez-Jaraba, María Valle; Buiza-Rueda, Dolores; Bonilla-Toribio, Marta; Adarmes-Gómez, Astrid; Carrillo, Fátima; Gómez-Garre, Pilar; Mir Rivera, Pablo; Universidad de Sevilla. Departamento de Medicina; Instituto de Biomedicina de Sevilla (IBIS)); Consejería de Salud de la Junta de Andalucía; Programa "Rio Hortega" del Instituto de Salud Carlos III (ISCIII-FEDER); Instituto de Salud Carlos III-Fondo Europeo de Desarrollo Regional (ISCIII-FEDER); Consejería de Economía, Innovación, Ciencia y Empleo de la Junta de Andalucía; Consejería de Salud y Familias de la Junta de Andalucía; Consejería de Salud y Bienestar Social de la Junta de Andalucía
Increased bilirubin levels in Parkinson's disease
(Elsevier, 2019-01-14) Macías-García, Daniel; Méndez-Del Barrio, Carlota; Jesús, Silvia; Labrador Espinosa, Miguel Ángel; Adarmes-Gómez, Astrid; Vargas-González, Laura; Carrillo, Fátima; Gómez-Garre, Pilar; Mir Rivera, Pablo; Universidad de Sevilla. Departamento de Medicina; Consejeria de Economia, Innovacidn, Ciencia y Empleo de la Junta de Andalucia; Consejeria de Salud y Bienestar Social de la Junta de Andalucia; Instituto de Salud Carlos III-Fondo Europeo de Desarrollo Regional (ISCIII-FEDER)
Introduction: Oxidative stress plays a key role in Parkinson's disease (PD) etiopathology. Heme oxygenase, an important enzyme which regulates oxidative balance, converts heme molecules into carbon monoxide, iron and biliverdin/bilirubin. The role of bilirubin has not been fully studied in PD, showing controversial results over the last few decades. Our aim was to investigate the relationship between bilirubin levels and PD. Secondly, we sought to evaluate the link between bilirubin concentration with PD progression, severity and dopaminergic treatment. Methods: We included 420 PD patients (56% males, mean age: 64 ± 12 years) and 435 healthy controls (47% males, mean age: 58 ± 17 years). Bilirubin levels in both groups were compared using linear regression and multivariate analysis adjusted according to age and sex. Secondly, a case study with the PD cohort was carried out and bilirubin levels were correlated with current treatment, duration and severity of disease. Results: Bilirubin levels were significantly higher in PD patients than in controls (PD: 0.56 ± 0.26 mg/dl, controls: 0.45 ± 0.22 mg/dl; p < 0.001). In PD patients, we demonstrated a negative correlation between bilirubin levels and disease duration (p < 0.05). Higher bilirubin concentrations were identified in PD patients with Hoehn & Yahr stage ≤3. No relationship between bilirubin and treatment was found in PD patients. Conclusions: Increased bilirubin levels are particularly related to the first years of PD. Overexpression of oxidative enzymes could play an important role in PD etiology, leading to higher bilirubin levels in the early stages of PD.
5-ASA: una vieja molécula muy actual en el tratamiento de la colitis ulcerosa
(Aula Médica, 2012) Jiménez-García, A; Argüelles Arias, Federico; Castro-Laria, Luisa; Caunedo-Álvarez, Á.; Herrerías-Gutiérrez, JM.; Universidad de Sevilla. Departamento de Medicina
La utilidad de los salicilatos en la Colitis Ulcerosa (CU) fue descubierta hace ya más de 50 años, pero a pesar de eso, y debido a los avances que se han producido en su formulación y galénica, reduciendo gran parte de los efectos adversos, deben seguir siendo, sin duda alguna, el eje principal del tratamiento de todo paciente con Colitis Ulcerosa.
¿Cómo funcionan las salas de hospitalización de digestivo en Andalucía? ¿Qué es mejorable? Encuesta a 13 hospitales.
(Aula Médica, 2012) Argüelles Arias, Federico; Herrerías-Gutiérrez, J.M.; Márquez-Galán, J.L.; Caunedo-Álvarez, Á.; Romero-Gómez, M.; García-Fernández, F.J.; Dios-Vega, J.F. de; Teresa-Galván, J. de; Salmerón-Escobar, J.; Sánchez-Cantos, A; Vega-Sáenz, J.L.; Naranjo-Rodríguez, A.; Pérez-Moreno, J.M.; López-Cepero Andrada, J.; Ramos-Lara, M; Universidad de Sevilla. Departamento de Medicina
Introducción No existen datos de cómo funcionan las Hospitalizaciones de nuestra especialidad y qué características deberían tener para conseguir una mayor eficacia y calidad. Objetivos Conocer cómo funcionan las Salas de Hospitalización de Digestivo en Andalucía. Elaborar conclusiones sobre la infraestructura necesaria de las salas de hospitalización para su adecuado funcionamiento. Materiales y métodos Estudio prospectivo y multicéntrico, que consta de 79 preguntas, con una única posible respuesta. Tras una pregunta en la que se evalúa el estado real de la sala, se realiza otra en la que se valora qué sería lo ideal en relación a esa cuestión. Han participado 13 Hospitales. Resultados La mayoría de los Hospitales atienden 20 o más camas, cuyos enfermos proceden de Urgencias, sin supervisión por parte del Servicio. El número de camas asignado/especialista es 10, si bien la mayoría considera que debería ser entre 8-10 camas. La estancia media es igual o superior a 5. En cuanto a los tiempos de espera para la realización de las pruebas destaca que en un 54% de los casos el tiempo para realizar una RNM es de más de 5 días. Por último, destacar que en la mayoría de los Hospitales no existe restricción a la entrada de familiares, lo que se considera necesario por la mayoría de los servicios. Conclusiones Las salas de Hospitalización de Digestivo de los Hospitales andaluces funcionan a un buen nivel según los encuestados, aunque existen parámetros que deben mejorar para conseguir un mayor nivel de calidad en su actividad diaria.
Epsilon Wave in Arrhythmogenic Cardiomyopathy
(Instituto Panvascular de Occidente, S.C., 2024-04-22) López-Flores, Luis; Cózar León, Rocío; Díaz Infante, Ernesto; Universidad de Sevilla. Departamento de Medicina
Joint position statement by "Sociedad Española de Patología Digestiva" (Spanish Society of Gastroenterology) and "Sociedad Española de Farmacología" (Spanish Society of Pharmacology) on biosimilar therapy for inflammatory bowel disease
(Aran Ediciones, 2013) Argüelles Arias, Federico; Barreiro-de-Acosta, Manuel; Carballo, Fernando; Hinojosa, Joaquín; Tejerina, Teresa; Universidad de Sevilla. Departamento de Medicina
Biological drugs or biopharmaceutical products, manufactured with or from living organisms using biotechnology, have represented a therapeutic revolution for the control of inflammatory bowel disease (IBD). At present, in this indication and in our country, only two biologicals are approved, infliximab (IFX) and adalimumab (ADA), both of them monoclonal antibodies against tumor necrosis factor alpha. Effectiveness data are strong for both therapies, with maximum levels of scientific evidence. The upcoming expiry date for these biologicals' patents has allowed the potential marketing of so-called biosimilar agents for the IBD indication. While biosimilars are conceptually for biologicals what generics are for chemical drugs, the structural complexity of biosimilars and their biological and manufacturing variability lead to consider validation processes for these two types in humans as highly differential. Thus, in our setting, under the coverage of "Agencia Española del Medicamento y Productos Sanitarios (AEMPS)" (Spanish Agency of Medicines and Medical Devices), guidelines issued by the European Medicines Agency (EMA) are to be applied, which states that a number of stages or steps must be overcome in order to obtain approval for a biosimilar agent. However, despite the presence of these recommendations by EMA, which must be met by a biosimilar in order to be licensed in our marketplace, relevant uncertainties persist that only future decisions by EMA and AEMPS may clarify. The present stance by our task force is that biosimilar development should be undertaken according to established regulations, thus certifying their efficacy and safety. Similarly, this task force considers that results obtained from studies in rheumatoid arthritis (RA) should not be extrapolated to IBD since the biological variability of these complex structures will not ensure a lack of noticeable changes in efficacy and safety.
Dispepsia "sin signos de alarma" como presentación inicial de Leiomiosarcoma multicéntrico
(Aula Médica, 2013) Duarte-Chang, Calixto; Cedeño-Zambrano, A; Argüelles Arias, Federico; Prado-Alba, C del; Pellicer-Bautista, Francisco Javier; Caunedo-Álvarez, A; Universidad de Sevilla. Departamento de Medicina
El leiomiosarcoma es una de las neoplasias más comunes de tejidos blandos, que usualmente se localizan en tejidos profundos que contengan músculo liso. Forman parte del grupo de neoplasias de origen mesenquimal, que a diferencia de los GISTs, su incidencia es más baja y no presentan positividad para el marcador inmunohistoquímico c-Kit (CD117)[1]. El diagnóstico se intuye tras la evidencia de una masa de aspecto submucoso en la endoscopia, con mucosa superficial de aspecto normal, con márgenes lisos, y que en algunos casos puede presentar una ulceración central. Presentamos el caso inusual de una mujer de 50 años con clínica de dispepsia de un mes de evolución, sin signos de alarma, a la que se le solicitó una endoscopia digestiva alta, que reveló en curvatura mayor, una lesión exofítica, de unos 2 cm, de aspecto submucoso al igual que otra de menor tamaño situada en antro. La histología junto con la inmunohistoquímica, reveló que ambas lesiones eran de origen mesenquimal, compatibles con Leimiosarcoma. Tras estudios de extensión se observaron metástasis a distancia y regionales.
Complicación y manejo de cuerpo extraño esofágico de 48h de evolución
(Aula Médica, 2014) Duarte-Chang, Calixto; Cordero-Ruiz, P; Argüelles Arias, Federico; Pellicer-Bautista, Francisco Javier; Caunedo-Álvarez, A; Herrerías-Gutiérrez, J.M; Universidad de Sevilla. Departamento de Medicina
La impactación de cuerpo extraño esofágico de tipo alimenticio se observa de forma frecuente en la práctica clínica habitual, con una incidencia de complicaciones que varían desde erosiones de la mucosa superficial hasta ulceraciones con un riesgo vital significativo. Presentamos el caso de un varón de 52 años, con antecedentes de estenosis péptica, que acude a urgencias por cuerpo extraño esofágico impactado de más de 48h de evolución junto a una laceración esofágica secundaria. Al paciente se le realizó una esofagogastroscopia de urgencia, donde se observó un bolo cárnico situado en el tercio medio esofágico, junto con restos hemáticos y una ruptura intramural o laceración de la mucosa esofágica de unos 5cms de longitud, situada a este nivel. Mediante el uso de asa de polipectomía, se extrajo el bolo cárnico en su totalidad, sin incidencias inmediatas y sin precisar tratamiento quirúrgico durante su estancia intrahospitalaria. El paciente evolucionó favorablemente mediante manejo conservador. De tal forma, que ante la ausencia de signos de perforación u algún otro signo de complicación, este manejo sería el recomendable.
Preparations for colon capsule endoscopy: prospective and randomized comparative study between two preparations for colon capsule endoscopy: PEG 2 liters + ascorbic acid versus PEG 4 liters.
(Aran Ediciones, 2014) Argüelles Arias, Federico; San-Juan-Acosta, Mileidis; Belda, Alba; García-Montes, Josefa María; Pellicer, Francisco; Polo, Juan; Caunedo-Álvarez, Ángel; Herrerías-Gutiérrez, Juan Manuel; Universidad de Sevilla. Departamento de Medicina
Introduction: PillCam© colon capsule endoscopy (CCE) enables the study of colonic diseases in a safe and non-invasive way, although there are aspects that need to be improved. Current methods of bowel preparation lead to discordant rates of adequate cleansing and CCE excretion. Aims: To compare the efficacy of colon cleansing using two different regimes (2L PEG plus ascorbic acid versus 4L PEG alone) for PillCam Colon (C2) capsule endoscopy. Methods: Fifty eight patients included in this prospective study and randomized to: Group A, PEG plus ascorbic acid regimen (n = 28, 12 F/16 M) or group B, PEG alone regimen (n = 30, 14 F/16 M). The degree of cleansing was categorized into "excellent-good" or "fair-poor", according to Leighton's recently published preparation scale. CCE excretion rate and colon cleansing were assessed. Patients underwent to PillCam colon of second generation (C2). Results: Cleansing was considered to be excellent-good in 78 % of cases in group A and in 64 % of cases in group B, with no significant difference between the groups (p = 0.252). Nevertheless, when the grade of cleansing was analyzed in segments, a significant difference was found in the cecum and transverse colon. No differences were observed in the bubble effect between preparations. The excretion rate was 93 % in group A versus 70 % in group B (p = 0.043). Conclusions: These results suggest that a 2L PEG plus ascorbic acid regimen is at least as effective as a 4L PEG regimen. This regimen may be considered an effective alternative which would improve compliance because a smaller volume is required.
Spanish consensus on managing pregnancy in women with Gaucher disease
(Biomed Central Ltd; Bmc (Biomed Central); Bmc, 2025-03-28) Calderón Sandubete, Enrique José; Rodríguez-Fernández, Alicia; Calderón-Baturone, Irene; Aporta-Rodríguez, Rafael; Castillo, Francisco J. del; García Díaz, Lutgardo; González-Meneses, Antonio; Hermosín-Ramos, María Lourdes; Yahyaoui, Raquel; Marín-León, Ignacio; Universidad de Sevilla. Departamento de Medicina; Universidad de Sevilla. Departamento de Cirugía
Gaucher disease can have effects on the development of pregnancy, childbirth, and lactation, with impact on health of both the mother and the newborn. Management of pregnancies in Gaucher patients is further complicated by using of enzyme replacement therapy. Unfortunately, the available scientific evidence is not conclusive because there are not proper clinical trials on this issue. The aim of this work was to establish a management guide to address the main clinical problems before, during and after pregnancy and to provide key information to healthcare professionals, patients, and families. GRADE methodology to evaluate the quality of scientific evidence and develop recommendations was incorporated to elaborate this guide. For final recommendations, a structured consensus 2-round process was carried out using the Delphi method with a Gaucher expert panel. After this process, nine recommendations were elaborated related to pre-pregnant status and genetic counseling and for management during pregnancy, seven related to childbirth, and eight focused on management after delivery and breastfeeding. Regarding the quality of the evidence, values and preferences of patients were also considered. A consensus guide to define and standardize pregnancy management in Gaucher disease considering the best available evidence, complemented by experts’ opinions, could be a relevant tool to help patients, nurses, midwives and physicians with little experience in Gaucher disease who do not have access to guidance from Gaucher disease treatment centers of excellence.
The management of lactose intolerance among primary care physicians and its correlation with management by gastroenterologists: The SEPD-SEMG national survey
(Aran Ediciones, 2015) Argüelles Arias, Federico; Rodríguez-Ledo, Pilar; Tenías, José María; Otero, Mercedes; Casellas, Francesc; Blay-Cortés, Guadalupe; Lucendo, Alfredo J.; Domínguez-Jiménez, José Luis; Mateo-Carballo, Fernando; Universidad de Sevilla. Departamento de Medicina
Introduction and aims: The understanding of lactose intolerance (LI) is limited in some professional settings. Sociedad Española de Patología Digestiva (SEPD) and Sociedad Española de Medicina General (SEMG) have developed a survey in order to: a) Analyze primary care physicians (PCPs) knowledge and clinical management; and b) to compare results with those of a previous survey of Spanish gastroenterologists (GEs). Material and methods: An online questionnaire was sent to SEMG members with 27 items on various issues: Demographics, occupational characteristics, outlook on LI, diagnostic tests, treatment, and follow-up. Results were compared to those from a survey of GEs. Results: A total of 456 PCPs responded, versus 477 GEs. PCPs had an older mean age and longer professional experience. Level of understanding of LI was similar, albeit a higher proportion of PCPs lacked epidemiological awareness (p < 0.01). GEs tended to consider LI a “minor” condition (71.3 vs. 40.1%; p > 0.001), and LI symptoms as overlapping those of irritable bowel syndrome (93.5 vs. 88.2%; p = 0.005), although symptoms perceived as suspicious of LI were similar in both groups. Dietary recommendations were recognized as the primary therapeutic approach. Conclusion: This study reveals the outlook of PCPs on LI, and allows comparison with that of GEs, as a basis for the development of strategies aimed at improving LI understanding, approach and management in our setting.
Influence of Cellular Aging on Liver Stiffness in Patients With Hepatitis C Virus Achieving Sustained Viral Response
(Oxford, 2025) González-Serna Martín, Manuel Alejandro; Corma Gómez, Anaïs; Cano Rodríguez, María Mercedes; Rubio Sánchez, Ricardo; Martín Sierra, Carmen; Rincón, Pilar; Martín Carmona, Jesica; Pérez, Margarita; Pineda Vergara, Juan Antonio; Real, Luis Miguel; Macías Sánchez, Juan; Universidad de Sevilla. Departamento de Fisiología; Universidad de Sevilla. Departamento de Medicina; Instituto de Salud Carlos III
Background. Liver stiffness (LS) is not reduced in 10%–30% of patients who achieve sustained viral response (SVR) after hepatitis C virus (HCV) elimination with direct-acting antivirals (DAA). Our aim was to analyze whether the parameters associated with cellular aging measured at the DAA initiation date are related to LS reduction upon achieving SVR. Methods. In a prospective cohort study (GEHEP-011) we measured several parameters associated with cellular aging, such as telomere attrition, mitochondrial alterations, and soluble biomarkers associated with senescence-associated secretory phenotype at the DAA initiation date, and examined their associations with a significant (≥20%) LS decrease at the SVR time point. Results. In total, 175 individuals were included in this study. In 101 (57.7%) patients, the LS reduction was ≥20% at SVR. In the multivariate analysis adjusted for sex, age, CXCL10, hsPCR, and CCL11 levels, greater relative telomere length (RTL) emerged as the sole variable independently associated with a significant LS decrease in SVR (1.102; 95% confidence interval, 1.001–1.1214; P = .047). Furthermore, changes in LS, including significant decrease, decrease <20%, or increase, were congruently associated with RTL (P = .011). Conclusions. Greater RTL was independently associated with a significant LS reduction in SVR. Thus, increased cellular aging may be responsible for the absence of liver regeneration after HCV eradication. Further studies are required to assess the long-term effects of cellular aging after SVR.
Guideline for wireless capsule endoscopy in children and adolescents: A consensus document by the SEGHNP (Spanish Society for Pediatric Gastroenterology, Hepatology, and Nutrition) and the SEPD (Spanish Society for Digestive Diseases)
(Aran Ediones, 2015) Argüelles Arias, Federico; Fernández-Urien, Ignacio; Alberca, Fernando; Argüelles Martín, Federico; Martínez, María José; Molina, Manuel; Varea, Vicente; Herrerías-Gutiérrez, , Juan Manuel; Ribes-Koninckx, Carmen; Universidad de Sevilla. Departamento de Medicina
Introduction: Capsule Endoscopy (CE) in children has limitations based mainly on age. The objective of this consensus was reviewing the scientific evidence. Material and methods: Some experts from the Spanish Society of Gastroenterology (SEPD) and Spanish Society for Pediatric Gastroenterology, Hepatology, and Nutrition (SEGHNP) were invited to answer different issues about CE in children. These sections were: a) Indications, contraindications and limitations; b) efficacy of CE in different clinical scenarios; c) CE performance; d) CE-related complications; e) Patency Capsule; and f) colon capsule endoscopy. They reviewed relevant questions on each topic. Results: The main indication is Crohn's disease (CD). There is no contraindication for the age and in the event that the patient not to swallow it, it should be administered under deep sedation with endoscopy and specific device. The CE is useful in CD, for the management of OGIB in children and in Peutz-Jeghers syndrome (in this indication has the most effectiveness). The main complication is retention, which should be specially taken into account in cases of CD already diagnosed with malnutrition. A preparation regimen based on a low volume of polyethylene glycol (PEG) the day before plus simethicone on the same day is the best one in terms of cleanliness although does not improve the results of the CE procedure. Conclusions: CE is safe and useful in children. Indications are similar to those of adults, the main one is CD to establish both a diagnosis and disease extension. Moreover, only few limitations are detected in children.
Impaired motor cortical plasticity associated with cannabis use disorder in young adults
(Wiley, 2020-04-23) Martín Rodríguez, Juan Francisco; Ruiz Veguilla, Miguel; Álvarez de Toledo, Paloma; Aizpurúa Olaizola, Oier; Zarandona, Iratxe; Canal Rivero, Manuel; Rodríguez Baena, Antonio; Mir Rivera, Pablo; Universidad de Sevilla. Departamento de Psicología Experimental; Universidad de Sevilla. Departamento de Psiquiatría; Universidad de Sevilla. Departamento de Medicina; Junta de Andalucía; Fundación Alicia Koplowitz; Fundación Mutua Madrileña; Fundación Progreso y Salud; Instituto de Salud Carlos III; European Commission (EC). Fondo Europeo de Desarrollo Regional (FEDER); Sociedad Andaluza de Neurología; Universidad de Sevilla
Maladaptive cortical plasticity has been described in individuals with heroin and methamphetamine addiction and may mediate other substance abuse disorders. It is unknown whether cannabis dependence in humans alters the capacity for induction of cortical plasticity. The aim of this study was to non-invasively investigate cortical plasticity with transcranial magnetic stimulation in young adults who meet DSM-5 criteria for cannabis use disorder (CUD). Thirty men (ages 20– 30) who used cannabis daily over the previous 6 months (15 diagnosed of CUD) and 15 demographically matched non-users were enrolled in this study. All participants underwent two sessions of theta burst stimulation (TBS) in which either continuous TBS (cTBS; 600 pulses, 80% active motor threshold) or intermittent TBS (iTBS; 2-s train of cTBS repeated every 10 s for a total of 190 s, 600 pulses) was applied over the primary motor cortex. The effects of these protocols were assessed by analysing the contralateral motor evoked potentials (MEPs). The relationships between cortical plasticity and problematic cannabis use, degree of dependence, and nicotine addiction were also investigated. Significant MEP inhibition after cTBS was observed in both cannabis users without CUD and non-users, while this inhibition was not seen in cannabis users with CUD. Strikingly, less motor cortical plasticity was observed in subjects with severe problematic cannabis use. No significant differences between users and non-users were found in the iTBS-induced cortical plasticity measures. Our study provides the first evidence of maladaptive cortical plasticity associated with cannabis use disorder and problematic cannabis use in humans.
Short-afferent inhibition and cognitive impairment in Parkinson's disease: A quantitative review and challenges
(Elsevier, 2020-02-06) Martín Rodríguez, Juan Francisco; Mir Rivera, Pablo; Universidad de Sevilla. Departamento de Medicina; Universidad de Sevilla. Departamento de Psicología Experimental; Junta de Andalucía; Fundación Alicia Koplowitz; Fundación Mutua Madrileña; Fundación Progreso y Salud; Instituto de Salud Carlos III; European Commission (EC). Fondo Europeo de Desarrollo Regional (FEDER); Sociedad Andaluza de Neurología
Traditionally, Parkinson’s disease (PD) has been considered a single neurotransmitter (dopaminergic) disease. However, research over the past 20 years has shed light on the involvement of multiple neurotransmission systems, in particular, the cholinergic system. Research has mainly focused on the role of this system in the pathophysiology of PD and its implications in the development of motor and non-motor disorders. Short-latency sensory afferent inhibition (SAI), investigates sensori-motor integration, and has emerged as a putative neurophysiological marker of cholinergic function in the human brain. In this quantitative review, a moderate-to-severe reduction in SAI was observed in PD patients. Furthermore, through moderator analysis, the impairment of SAI was shown to be associated with disease duration and therapeutic state. Patients under dopaminergic agents (“on” state) displayed worse SAI than those after dopaminergic agent withdrawal (“off”). We further assess the potential value of SAI as a marker of cognitive impairment in PD, and its association with four specific cognitive domains. This analysis revealed that patients with cognitive impairment displayed significantly lower levels of SAI than those without cognitive impairment. To conclude, a set of challenges to be addressed before SAI can be validated as a useful clinical tool in PD are presented.
Abordaje diagnóstico de la diarrea crónica en adultos
(Aula Médica, 2015) Jiménez-García, V.A.; Argüelles Arias, Federico; Carmona-Soria, I; Caunedo-Álvarez, A; Romero-Gómez, M; Universidad de Sevilla. Departamento de Medicina
La diarrea crónica es motivo de consulta relativamente frecuente y dado que es una patología compleja requiere un abordaje diagnóstico estructurado. Por el aspecto de las heces se puede clasificar en tres grupos: acuosa, grasa e inflamatoria. Las causas pueden ser múltiples, pero el primer paso en el diagnóstico es realizar una adecuada historia clínica para determinar si se trata de un problema funcional u orgánico, y tratar de identificar aquellos pacientes con datos de alarma que requieran ser estudiados y diagnosticados de forma preferente.

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